Augmentation

gulliver · Post by **gulliver** » Wed Oct 21, 2009 2:34 am

My internist, who I went to see yesterday because of high blood pressure, said I am augmenting on ropinirole (Requip) because I have had almost nonstop RLS for almost a week. and it is driving me crazy. I had been taking four (4) ropinirole (l mg.) tablets daily (2 in the morning and 2 before bedtime ) as recommended by my neurologist. I also take one clonazepan (1 mg) at bedtime. The neurologist said these doses were not too high when I asked her about all the ropinhirole I was taking.

Now beginnining yesterday on the advice of my GP I only took one Ropinirole and one clonzipan at bedtime. Didn't get to sleep for hours so took 2nd ropinirole in middle of the night. Finally got to sleep for a few hours.

Today, as my GP recommended, I had one Ropinirole and one clonazepam at bedtime. I have constant feelings of pins and needles in my feel and uncontrollable urges to move my feet. I am exhausted.

Should I listen to my GP or my neurologist? They are both in the same medical group in Southern Maryland and both claim to be knowledgeable about RLS. I am inclined to drop them both and try to get into Johns Hopkins sleep center which has a dept. on RLS.

Does anyone have ANY suggestions? How long does augmentation last?
Thanks, very much.

jessdell · Post by **jessdell** » Wed Oct 21, 2009 3:26 am

My (very basic) understanding of augmentation, from what my neurologist Dr. Rye told me, is that it lasts as long as you continue on the medicine causing it. Apparently, once it causes augmentation, you're supposed to go off the medicine for a while and then try again, usually in a month or so I think. At that point, the medicine may become effective again, but its hard to say how long it will be effective because I think that's more something that varies person-to-person.

As for going to see someone who specializes in RLS, I definitely recommend it, not because all other doctors are ignorant or uninformed (although my GP was), but because people specializing in RLS have far more experience and may be able to help you get on a medicine that will help you rather than cause you so many problems.

Anyway like I said, that's just briefly what I was told about augmentation by my doctor the other day, but we didn't really talk about it much because he said with my RLS being so extremely severe, its hard to imagine it getting any worse. hah anyway, I hope you find relief soon! Good luck, and maybe check out the RLS Dept. at John Hopkins?

SquirmingSusan · Post by **SquirmingSusan** » Wed Oct 21, 2009 3:45 am

What is your internist hoping to accomplish by having you drop your dosage of Requip? If you are augmenting, the only way to get past that is to stop the drug completely, while using an opioid to help with symptom control. Then after a month or two, you can possibly take a dopamine agonist again, either Requip or Mirapex.

Just cutting down on the Requip is only going to make your RLS go crazy.

Neco · Post by **Neco** » Wed Oct 21, 2009 4:30 pm

GET OFF REQUIP NOW

Go to your GP or Neuro or whoever you will have the most luck with, take a print out of The Mayo Clinic Algorithm for RLS, linked to in my signature, and show them the instructions on how to deal with augmentation.

You should be taken off the medication and given a moderate to strong opiate like Oxycodone to get through the next couple of weeks until your RLS returns to pre-augmentation levels of severity.

Once you stop Requip or Mirapex, your RLS will increase beyond what you are experiencing now, and most experts agree it is completely acceptable to take opiates during the following few weeks, until RLS calms back down..

At that point, you can either decide if you want to stay on opiates, if your doctor will let you, or you can try again with another medication.

gulliver · Post by **gulliver** » Wed Oct 21, 2009 8:24 pm

Many thanks to those who responded to my question re augmentation. I have a call in to my doctor now to ask for an opiod prescription and to let him know that I will not take any more Requip until this settles down. Haven't slept for a long, long time and this is getting serious. I must act quickly because I can't take it much longer.

All of you are very kind to share your knowledge with people like me and I really appreciate your thoughtfulness.

Neco · Post by **Neco** » Wed Oct 21, 2009 8:52 pm

I hope it comes through for you..

Truthfully I don't think we have a very high success rate of people just putting in calls to have an opiate prescription given.. It usually involves a lot of bickering on the patients parts and physically being there and having the papers in hand to prove its even appropriate for them to be given.. And even then a lot of doctors stubbornly refuse.

I do hope it works out for you though.

Post by **ViewsAskew** » Thu Oct 22, 2009 6:17 am

Gulliver - you might want to handle this carefully. Your doctor could misinterpret your request as drug seeking.

The CLinical Management of RLS, a book written by Hening, Buchfurer and Lee, clearly details how to handle augmentation if I remember correctly.

I'd get a copy of that express mailed to you and take it to him, copying or showing him what needs to happen. Then it's not you asking, but other specialists telling.

gulliver · Post by **gulliver** » Thu Oct 22, 2009 9:46 am

Thanks. I have the book and will do what you suggest. Right now it's 5:30' . a.m. and I haven't been able to sleep one minute. I'm thinking of trying to get someone to drive me to the ER (I live qlone) Didn't sleep last night either.

Post by **ViewsAskew** » Fri Oct 23, 2009 2:22 am

Oh, I am so sorry it's that bad. That is just a rotten place to be....and to have a doctor who means well (I am assuming) yet doesn't quite know what to do.

The ER can be a good or dangerous place. We've had people who were given inappropriate drugs in ER and it made things worse. They honestly do not know what to do with us in many cases.

Betty/WV · Post by **Betty/WV** » Fri Oct 23, 2009 11:47 am

Hi Gulliver: I feel so bad for what you are going through. I've been there, done that. You have been given some very good advice, I can't think of anything to add. Just wanted you to know, my thoughts and prayers are with you. Hope you find some relief soon. I know the desperation you are feeling. You just have to keep on trying to find a doctor to help you.

Take care, Gulliver and let us know how things turn out. BETTY/WV

gulliver · Post by **gulliver** » Fri Oct 23, 2009 11:50 am

Thank you, Betty. It is very comforting to hear from people like you.

Post by **Polar Bear** » Fri Oct 23, 2009 6:30 pm

Have you managed to talk to your doc about coming off requip/opiate prescription.

Hope you are getting some sleep.

gulliver · Post by **gulliver** » Fri Oct 23, 2009 9:33 pm

My internist, as well as the ER doctor, both said to take one Requip and one clonazepam each night before going to bed. (That's a decrease from 4 Requip prescribed by my neurologist, but RLS members advise me to go off Requip entirely.

There is no agreement on how to handle this. I did learn that celebrex which was given to me by an orthopedic surgeon for a knee injury (even though I had given him a list of my medications and physical condition) was causing the sleep problem. Last night I took a sonata but NO celebrex and did sleep for a few hours.

Monday I meet again with my internist to try to settle this once and for all. If it doesn't work I will just give up. I am so disappointed in all the conflicting advice from my doctors, I have no faith in any of them any more.

Many thanks for your note.

Post by **Polar Bear** » Sat Oct 24, 2009 5:23 am

Please don't lose heart.
I know you have a copy of Dr Bs book to show your doc, it might also be an idea to print out a copy of the Mayo Clinic Algorithm for easy reference.
Good luck on Monday.

Post by **ViewsAskew** » Sat Oct 24, 2009 9:38 am

Gulliver, I know how frustrating this can be. And, I've temporarily given up several times. In the end, I always come out fighting again, simply because it's MY life, not theirs, and I'm not willing to compromise my treatment because they aren't up to date or whatever.

Sometimes it takes me months to come out fighting again - because it's hard to do. I've been avoiding it for several months, maybe a year recently. But, last week I decided enough is enough. Time to take on my PC and challenge her to work with me or I have to find another. My guess is I'll be looking for another, but I want more and I'm not willing to suffer any longer.